Dutch Rojas

Expect this to be a major point of political contention

Private equity can save medicine. Unless we’re gonna blow the system up and start from scratch (like I proposed yesterday), good PE is the only chance medicine has at a bridge to get to when AI might be able to actually fix things. And I'm not saying that’s going to happen, just that if this was a movie, AI is the Frodo trying to get to Mt. Doom. The healthcare system is dying because it’s become a kludgeocracy. Real term - see yesterday’s post. But in short, it’s when the rules keep building up. We’re up to 600,000 pages of rules at this point. 4 million enforcers. Legitimate numbers. And the people in the system (doctors) have been coming up with workarounds for 60 years. But then the insurance companies and hospitals and government just come up with new rules. It never ends. And eventually the rules will win. But we’ve never had an ally. In academia the institution cares about maximizing inpatient billing and minimizing expenses. That means making docs do what they’re told and replacing them with non-doctors if they won’t. Independent private practice? I had people on my team. They helped find workarounds. But I’ll be honest. They were amateurs. Couldn’t go toe-to-toe with payers, with anybody. Bad PE? Worse. They were literally another layer in the ‘making rules that make my life worse’ hierarchy - as bad as a hospital. Saws doctors as replaceable widget makers. But good PE. Good PE saved me. And it can save medicine. Here’s why. When good PE gets big enough it can afford professionals. Real, honest to goodness pros. Our CEO? Our Chief People Officer, Chief Technology Officer, Chief Financial Officer, Chief Marketing Officer, Chief Growth Officer? And our Chief Payer Negotiation Officer? Don’t get me started. They’re not just pros, they’re top of the line, highly motivated pros. Hard to explain what it was like to have somebody help me. For the first time. In my career. Not just want to help me, but be competent enough and experienced enough to actually help me. The kludgeocracy? It’s not like they have easy fixes. But they built it. They understand it. They see it. They worked for it. Deep insider knowledge. It’s nuts. Honestly nuts. I still can’t believe it on some days. Actually getting to collaborate with people who are killers. Honestly. Killers. They want what I want. What we all want. To be paid fairly for providing efficient, quality patient care. Do they actually care about me, about medicine? Absolutely not. They care about ROIC. Return On Invested Capital. That’s it. Ruthless. Sharks. But they understand that in the long run, keeping a doctor happy keeps them productive. And making it fun enough so they don’t quit is good business. It’s efficient and patients are satisfied, revenue goes up. EBITDA goes up. So we’re aligned. I’ve got people on my team. People who ooze competence. People who are highly motivated. And they can afford the tools. The tools that matter. The capital to implement the AI that puts us on equal footing with payers. The data that isn’t cheap to access or analyze. The scale that means UHC has to pick up the phone when they call. The expensive lawyers to cover our asses. And I can hear it now. What about when they sell? How do you know the new PE won’t be bad PE again? I don’t. But unless you are the sole owner of your own practice, you don’t either. New chair in academia. Partner sells in a group, partner betrays you, office manager defrauds you. I’m not arguing good PE is perfect. I’m not arguing it doesn’t have risks. I’m just saying I’ve seen a lot. And good PE can save medicine. Not because they care. Because we’re aligned.